Social Therapy - Outcomes and Evaluation with Personality Disorder a Compatibility Mode by Dr Stanley J. Renwick

Personality Disorder Social Therapy
Framework - Service / Outcome and
Evaluation – commentary on a work in
progress

Presented by Stanley J. Renwick PhD
Ansel Clinic Nottingham

Presented to <client> by <presenters name>
© The Ansel Group, Ansel Clinic, Clifton Lane, Nottingham NG11 8NB, t: 0845 200 0465, f: 0115 984 1544, w:www.anselgroup.co.uk

Welcome to the Ansel Group
Ansel is the only nationally available, independent healthcare organisation solely dedicated to providing an
integrated and consistent care pathway for people with personality disorders who may have additional complex
needs and have challenged other service provision. Drawing on a team of experienced clinical practitioners and
professionals in the field of mental health and led by some of the most respected figures in the sector, Ansel will
deliver a community of mental health care services that will make a real and positive difference in the lives of all
involved.

Offering our services to the NHS and other independent sector providers, Ansel will deliver all of our services
within a Social Therapy Framework, focused on providing services that remain relevant to our patients whilst
enabling consistent competency, high quality, best value and inherent flexibility.

Our first purpose designed and built low secure, male personality disorder clinic opened in Nottingham early in
2010 and will followed by a second in 2011. Additional pathway provision is planned to enable delivery of a
national ‘community of communities’ to address the needs of this challenging, vulnerable and marginalised group
of people from forensic through to community based services.


The issues to be addressed

• Clinical Outcomes

• Service Outcomes

• Adherence to the Social Therapy Framework Model


Why do we audit the service?

• Do we do what we claim?

• If so do we do it well?

• Does this positively impact upon the client?


Definitional Requirement

Social therapy is the methodical management of the living
environment of a group of clients directed towards reaching the
treatment targets of this group and conceived as a means of
achieving the treatment targets of the individual client – within a
functional unit, usually a clinical treatment setting.

If the socio-therapists do not succeed in giving the client a
meaningful form of living together, working together and
employing free time together, all factors within the clinical
setting, then the clinical admission almost always has negative
consequences.


Social Therapy

The Fundamental Postulate:

A person’s psychological and/ or psychiatric difficulties are
operationalised and expressed in the interpersonal behaviours
which they exhibit and the relationships they develop.


The 4 Guiding Principles

1. Engagement Principle - A person’s social interactions, if
appropriately shaped and guided, can effect positive and
sustained change in interpersonal behaviour to a degree that
over time represents development in their functioning within
and understanding of the social world.

2. Replication Principle - When dysfunctional, a person’s
interpersonal difficulties and relationships are subject to
continuing replication and hence serve to perpetuate the
individual’s difficulties. This necessitates that any efforts to
support the person in addressing their problems must avoid
replicating the same pathological behaviours and
relationships they are targeting.


The 4 Guiding Principles

3. Developmental Principle - An individual’s dysfunctional
interpersonal behaviours and relationships arise as a consequence
of priming events and circumstances in an individual’s past life.
Over time, the difficulties that are expressed come to represent an
acquired developmental ‘lag’ or delay, in the manner in which the
person cognitively perceives and understands the interpersonal
world.
4. Containment Principle - when an individual’s interpersonal
behaviours and relationships become dysfunctional, this generates
considerable emotional and behavioural turbulence within their
immediate and wider social world. Efforts directed towards
remediation of such difficulties therefore require the active
management and containment of such turbulence. This is a
necessary pre-requisite for positive change and personal
development.


Practice Implications

Environmental

• Living space is designed in a manner which optimises social
interaction between both clients and clients and staff i.e.
social areas are at the heart of the layout.
• In parallel the clinic area more generally emphasises
collaboration – optimising spaces where staff and clients work
together on tasks.
• Building design and layout should minimise signals of control
and hierarchy – blending staff areas with the wider unit and
‘toning down’ overt security structures and organisational
hierarchies.



Organisational

• Organisational policies and practice guidelines should serve
to emphasise collaborative inclusive practice and minimise
hierarchy-based differences.
• The formal documentation regarding the client (e.g. CPA,
Tribunal) should evidence the critical focus placed upon the
individual’s interpersonal functioning, and the collaborative
approach taken by professional disciplines.
• Systems of staff communication and ‘handover’ should
provide the opportunity for reflective consideration of the
emotional and interpersonal implications of working with the
client. This should be integrated with the prepared formulatory
analyses.


Operational
• Unit practice should evidence the formulatory based approach
to working interpersonally with the client(s).
• The working week of the clients should evidence opportunity
for involvement in critically identified processes including task
groups and community meetings etc. This also evidencing
client contribution to the management of their social space.
• Routine practice should evidence the critical importance
placed by the approach on communication. In the case of
communication between:
– (a) staff and clients – this should reflect planned
interactional sequences
– (b) between staff – this should reflect appropriate use of
de-briefing processes

Impact Expectancies

• Regular staff de-briefing during and at the end of shifts.
• Reduced boundary tensions in respect of professional
practice issues (more specialist staff engagement in routine
clinic activities).
• Enhanced social communication between both patients and
patients and staff.
• Patient awareness of proposals regarding the developmental
circumstances underlying their difficulties (formulation).


Impact Expectancies

• Evidence of planned approaches towards management of
interactions with and between clients.
• Formal indication of the relationship between the individuals
interpersonal functioning and their presenting
complaints/diagnoses etc.
• Indication of patient engagement in the proactive
management and delivery of the social therapy milieu.
• Promotion of reflective practice in staff through adherence to
formal supervisory arrangements and involvement in
structured reflective practice opportunities.


Service Evaluation

Practice Impact
Implications Expectancies
Social Therapy Environmental

Social Therapy
Living space is designed in a manner which optimises • Regular staff de-briefing during and
social interaction between both clients and clients and
Fundamental Postulate :
staff i.e. social areas at the heart of the layout at the end of shifts
A person’s psychological and/or psychiatric difficulties
In parallel the clinic area more generally emphasises • Reduced boundary tensions in
collaboration – optimising spaces where staff and clients
are operationalised and expressed in the interpersonal
work together on tasks respect of professional practice
behaviours which they exhibit and the relationships
they develop.
Building design and layout should minimise signals of issues (more specialist staff
control and hierarchy – blending staff areas with wider
unit and ‘toning down’ overt security structures and
engagement in routine clinic
Guiding Principles:
organisational hierarchies activities)
Engagement Principle- A person’s social interactions, Organisational • Enhanced social communication
if appropriately shaped and guided, can effect positive between both patients and patients
and sustained change in interpersonal behaviour to a Organisational policies and practice guidelines should
degree that over time represents development in their serve to emphasise collaborative inclusive practice and and staff
minimise hierarchy-based differences
functioning within and understanding of the social
The formal documentation regarding the client (e.g. CPA,
• Patient awareness of proposals
world.
Replication Principle- When dysfunctional, a person’s Tribunal) should evidence the critical focus placed upon regarding the developmental
interpersonal difficulties and relationships are subject the individual’s interpersonal functioning, and the circumstances underlying their
to continuing replication and hence serve to collaborative approach taken by professional disciplines
perpetuate the individual’s difficulties. This Systems of staff communication and ‘handover’ should difficulties (formulation)
necessitates that any efforts to support the person in provide the opportunity for reflective consideration of the • Evidence of planned approaches
addressing their problems must avoid replicating the emotional and interpersonal implications of working with
the client. This should be integrated with the prepared towards management of
same pathological behaviours and relationships they
are targeting. formulatory analyses interactions with and between
Developmental Principle- An individual’s dysfunctional Operational clients
interpersonal behaviours and relationships arise as a
consequence of priming events and circumstances in
Unit practice should evidence the formulatory based • Formal indication of the relationship
approach to working interpersonally with the client(s)
an individual’s past life. Over time, the difficulties that
The working week of the clients should evidence between the individuals
are expressed come to represent an acquired
developmental ‘lag’ or delay, in the manner in which
opportunity for involvement in critically identified interpersonal functioning and their
processes including task groups and community meetings
the person cognitively perceives and understands the
etc. This also evidencing client contribution to the
presenting complaints/diagnoses
interpersonal world.
Containment Principle- when an individual’s
management of their social space etc.
Routine practice should evidence the critical importance • Indication of patient engagement in
interpersonal behaviours and relationships become
placed by the approach on communication. In the case of
dysfunctional, this generates considerable emotional the proactive management and
communication between
and behavioural turbulence within their immediate and
wider social world. Efforts directed towards
(a) staff and clients – this should delivery of the social therapy milieu
reflect planned interactional
remediation of such difficulties therefore require the
sequences • Promotion of reflective practice in
active management and containment of such
turbulence. This is a necessary pre-requisite for
(b) between staff – this should reflect staff through adherence to formal
appropriate use of de-briefing
positive change and personal development.
processes
supervisory arrangements and
involvement in structured reflective
practice opportunities


Client Outcome Profile

Socio-Cognitive Interpersonal
Structures & Functioning & Micro-
Processes Skills/Competencies

Person/Personality

Problem
Emotional Behaviours
Regulation &
Responsivity e.g. Forensic Risk,
Challenging Beh’s


Client Outcomes

• Socio-cognitive structures and processes
• Interpersonal perspective taking Selman (2003)

• Interpersonal functioning and skill competencies
• CIRCLE Blackburn & Renwick (1996)
• I.A.S Wiggins (1995)
• I.I.P Horowitz et al. (2000)
• Micro-Skills Assessment


Client Outcomes

• Personality
• MCMI II Millon et al.
• SCID II
• IPDE
• Emotion Regulations
• BDI
• BAI
• SCL-90
• NAS
• Problem Behaviour
• e.g. RISK HCR-20
• HoNOS-SECURE
• RAMAS etc.


Client Outcomes


Where we are now

Client Outcome Profile Service Evaluation

Practice Impact
Socio-
Interpersonal Social Therapy Implications Expectancies
Functioning &
Cognitive
Micro- • Regular staff de-briefing during and at the
Structures & Environmental end of shifts
Skills/Competenci Social Therapy • Reduced boundary tensions in respect of
Processes • Living space is designed in a manner which optimises social
professional practice issues (more
es Fundamental Postulate : interaction between both clients and clients and staff i.e. social
areas at the heart of the layout specialist staff engagement in routine clinic
A person’s psychological and/or psychiatric difficulties are • In parallel the clinic area more generally emphasises
collaboration – optimising spaces where staff and clients work activities)
operationalised and expressed in the interpersonal
behaviours which they exhibit and the relationships they together on tasks • Enhanced social communication between
• Building design and layout should minimise signals of control
develop.
and hierarchy – blending staff areas with wider unit and ‘toning
both patients and patients and staff
down’ overt security structures and organisational hierarchies • Patient awareness of proposals regarding
Guiding Principles:
Organisational the developmental circumstances
Person/Personality Engagement Principle- A person’s social interactions, if
appropriately shaped and guided, can effect positive and
• Organisational policies and practice guidelines should serve to
underlying their difficulties (formulation)
emphasise collaborative inclusive practice and minimise • Evidence of planned approaches towards
sustained change in interpersonal behaviour to a degree that hierarchy-based differences
over time represents development in their functioning within • The formal documentation regarding the client (e.g. CPA,
management of interactions with and
and understanding of the social world. Tribunal) should evidence the critical focus placed upon the between clients
Replication Principle- When dysfunctional, a person’s individual’s interpersonal functioning, and the collaborative • Formal indication of the relationship
interpersonal difficulties and relationships are subject to approach taken by professional disciplines
continuing replication and hence serve to perpetuate the • Systems of staff communication and ‘handover’ should provide between the individuals interpersonal
individual’s difficulties. This necessitates that any efforts to the opportunity for reflective consideration of the emotional and functioning and their presenting
support the person in addressing their problems must avoid interpersonal implications of working with the client. This should
be integrated with the prepared formulatory analyses complaints/diagnoses etc.
replicating the same pathological behaviours and
relationships they are targeting. Operational • Indication of patient engagement in the
Problem Developmental Principle- An individual’s dysfunctional
interpersonal behaviours and relationships arise as a • Unit practice should evidence the formulatory based approach
proactive management and delivery of the
social therapy milieu
Emotional Behaviours consequence of priming events and circumstances in an
individual’s past life. Over time, the difficulties that are •
to working interpersonally with the client(s)
The working week of the clients should evidence opportunity for • Promotion of reflective practice in staff
involvement in critically identified processes including task
Regulation & expressed come to represent an acquired developmental
‘lag’ or delay, in the manner in which the person cognitively
groups and community meetings etc. This also evidencing client through adherence to formal supervisory
contribution to the management of their social space arrangements and involvement in
Responsivity e.g. Forensic Risk, perceives and understands the interpersonal world.
Containment Principle- when an individual’s interpersonal
• Routine practice should evidence the critical importance placed
by the approach on communication. In the case of
structured reflective practice opportunities
behaviours and relationships become dysfunctional, this
Challenging BEHs generates considerable emotional and behavioural •
communication between
(a) staff and clients – this should reflect planned interactional
turbulence within their immediate and wider social world. sequences
Efforts directed towards remediation of such difficulties • (b) between staff – this should reflect appropriate use of de-
therefore require the active management and containment of briefing processes
such turbulence. This is a necessary pre-requisite for
positive change and personal development.


Social Therapy - Outcomes and Evaluation with Personality Disorder a Compatibility Mode by Dr Stanley J. Renwick

Recommended

Recommended

More Related Content

Similar to Social Therapy - Outcomes and Evaluation with Personality Disorder a Compatibility Mode by Dr Stanley J. Renwick

Similar to Social Therapy - Outcomes and Evaluation with Personality Disorder a Compatibility Mode by Dr Stanley J. Renwick (20)

Recently uploaded

Recently uploaded (20)

Social Therapy - Outcomes and Evaluation with Personality Disorder a Compatibility Mode by Dr Stanley J. Renwick